Efficacy of intralesional MMR vaccine in treatment of single or multiple refractory cutaneous warts

Introduction
The management of refractory warts continues to be a challenging task for the dermatologist. There are recent trends towards the use of intralesional immunotherapy by different antigens as they boost the cell-mediated immunity against human papilloma virus.

Objective
To evaluate the efficacy of intralesional MMR (measles, mumps, rubella) vaccine in the treatment of single or multiple refractory cutaneous warts.

Material and Methods
The study included 200 patients with single or multiple refractory cutaneous warts. They were injected with the MMR vaccine 0.5 ml intralesionally in a single wart or in the largest wart in the case of multiple cutaneous warts, every 2 weeks for a maximum of 5 treatments or the complete resolution of warts, whichever was earlier. The follow-up was done at the end of 5 MMR injections, at 3 months and at 6 months.

Results
Out of 200 patients, 191 completed the study. At the end of the study, 120 (62.8%) patients had complete resolution of all lesions, 8 (4.2%) had a partial response while no response was found in 63 (33%) of the patients.

Conclusions
Intralesional immunotherapy with the MMR vaccine is an effective and safe modality for the treatment of single or multiple refractory cutaneous warts.